XHealth Platform Benefits

XHealth Medical Scheme's Platform Benefits are designed to encourage health awareness, enhance quality of life, and provide peace of mind through preventative care and early detection tests. These benefits are paid for by the Scheme up to a maximum rand amount per benefit, determined by specific tariff codes.

Here's an elaboration on the various XHealth Platform Benefits:

XHealth Platform Benefits

General Rules and Pre-notification

While you generally do not need to pre-notify before using most XHealth Platform Benefits, pre-notification is required for preventative dental care, pap smears, HPV screening tests, general physical examinations, and HIV tests. You can easily pre-notify using the XHealth Solutions App, web chat facility, email, or by calling the XHealth Solutions Medical Scheme Service Centre.

Failure to pre-notify for the required benefits means the claim will not be paid from the XHealth Platform Benefit. Instead, it would be paid from XSaver, if available (for NormX, GrowX, and MotiveX Options), or from your Day-to-day Benefits, if available (for GearX and PinnacleX Options).

Additionally, if you are on the NormX, GearX, or MotiveX Options and have chosen "Associated" as your chronic provider, a 30% co-payment will apply if you do not use an Associated GP for GP consultations covered under the Health Platform Benefit.

For the OneX product, XHealth Platform Benefits are typically only available from your chosen Primary Care Network provider if you selected OneX Network hospitals or Any hospital. However, health assessments, maternity programme benefits, and baby immunisations (up to R2 950 in baby's first year) are available at any healthcare provider. If you chose Connect Network hospitals on the OneX product, you may use any healthcare provider for XHealth Platform Benefits.

A member of the XHealth Medical Aid is a beneficiary of XHealth.

Detailed Breakdown of XHealth Platform Benefits

Here's a breakdown of the specific benefits, who is eligible, how often they can be used, and which XHealth products they apply to:

1. Preventative Care

Baby Immunisations

• Who is eligible? Children up to age 6.
• How often? As required by the Department of Health.
• Applicable Options: All products.
• Note: On the OneX product, baby immunisations are covered in private facilities for the baby's first year, up to R2 950. Once this limit is reached or after the first year, immunisations are available at Department of Health baby clinics. On other products, no specific limit applies.

Flu Vaccines

• Who is eligible? Children between 6 months and 5 years, beneficiaries aged 60 and older, and high-risk beneficiaries.
• How often? Once a year.
• Applicable Products: All products.

Tetanus Diphtheria Injection

• Who is eligible? All beneficiaries.
• How often? As needed.
• Applicable Products: All products.

Pneumococcal Vaccine

• Who is eligible? Beneficiaries aged 60 and older, and high-risk beneficiaries.
• How often? Once a year.
• Applicable Products: GrowX, NormX, MotiveX, GearX, and PinnacleX.

2. Early Detection Tests

Preventative Dental Care

• What it covers: Up to R380 per beneficiary at dentists, dental therapists, and oral hygienists.
• Who is eligible? All beneficiaries.
• How often? Once a year.
• Applicable Products: All products.

Pap Smear Consultation

• What it covers: Consultation with a nurse, GP, or gynaecologist.
• Who is eligible? Women 15 and older.
• How often? Based on the type of pap smear.
• Applicable Products: OneX - Nurse or GP consultation, GrowX, NormX, MotiveX, GearX, PinnacleX - Nurse, GP, or gynaecologist consultation.

Pap Smear (Pathologist)

• Standard or LBC (Liquid Based Cytology):
• Who is eligible? Women 15 and older.
• How often? Once a year.

HPV PCR Screening Test: (If the result indicates high risk, a follow-up LBC is also covered)

• Who is eligible? Women 21 to 65.
• How often? Once every 3 years.
• Applicable Products: All products.

Mammogram

• Who is eligible? Women 38 and older.
• How often? Once every 2 years.
• Applicable Prodcuts: GrowX, NormX, MotiveX, GearX, and PinnacleX.

DEXA Bone Density Scan (radiologist, GP, or specialist)

• Who is eligible? Beneficiaries 50 and older.
• How often? Once every 3 years.
• Applicable Products: GrowX, NormX, MotiveX, GearX, and PinnacleX.

General Physical Examination (GP consultation)

• Who is eligible? Beneficiaries older than 21
• How often? Ages 21 to 29: Once every 5 years, Ages 30 to 59: Once every 3 years, Ages 60 to 69: Once every 2 years, Ages 70 and older: Once a year.
• Applicable Products: All products.

Prostate Specific Antigen (PSA) Test (pathologist)

• Who is eligible? Men older than 40
• How often? Ages 40 to 49: Once every 5 years, Ages 50 to 59: Once every 3 years, Ages 60 to 69: Once every 2 years, Ages 70 and older: Once a year.
• Applicable Products: All products.

Health Assessment (includes blood pressure test, cholesterol and blood sugar finger prick tests, height, weight, and waist circumference)

• Who is eligible? All principal members and adult beneficiaries.
• How often? Once a year.
• Applicable Products: All products.
• Where to get it: Digitally on the XHealth Solutions App or in person at Dis-Chem, Clicks, or any pharmacy near you.

Cholesterol Test (pathologist)

• Who is eligible? Principal members and adult beneficiaries.
• How often? Once a year.
• Note: Only covered if in-person health assessment results indicate a total cholesterol of 6 mmol/L and above.
• Applicable Products: All products.

Blood Sugar Test (pathologist)

• Who is eligible? Principal members and adult beneficiaries.
• How often? Once a year.
• Note: Only covered if in-person health assessment results indicate blood sugar levels are 11 mmol/L and above.
• Applicable Products: All products.

Glaucoma Test

• Who is eligible? Beneficiaries older than 40
• How often? Ages 40 to 49: Once every 2 years, Ages 50 and older: Once a year.
• Applicable Products: GrowX, NormX, MotiveX, GearX, and PinnacleX.

HIV Test (pathologist)

• Who is eligible? Beneficiaries 15 and older.
• How often? Once every 5 years.
• Applicable Products: All products.

3. Maternity Programme (Requires registration between 8 and 20 weeks of pregnancy)

Doula Benefit (Gynaecologist must be an Associated Specialist)

• Who is eligible? Women registered on the programme.
• How often? 2 visits per confinement, covered up to R2 300 (GrowX, NormX) or R2 400 (GearX, MotiveX, PinnacleX).
• Applicable Products: GrowX, NormX, MotiveX, GearX, and PinnacleX.

Antenatal Visits (Midwives, GP, or gynaecologist)

• Who is eligible? Women registered on the programme.
• How often? OneX: 7 visits, GrowX, NormX, MotiveX, GearX, PinnacleX: 12 visits.
• Applicable Products: All products.

Online Antenatal and Postnatal Classes

• Who is eligible? Women registered on the programme.
• How often? 18-month subscription, covered at negotiated rates.
• Applicable Options: MotiveX, GearX, and PinnacleX.
• Online Video Consultation with Lactation Specialist (offered through BellyBabies)
• Who is eligible? Women registered on the programme.
• How often? MotiveX: Initial consultation, GearX and PinnacleX: Initial consultation plus follow-up.
• Applicable Products: MotiveX, GearX, and PinnacleX.

Nurse Home Visits

• Who is eligible? Women registered on the programme.
• How often? All Options: 1 visit (the day after returning from hospital). GrowX, NormX, MotiveX, GearX, PinnacleX: Additional visit 2 weeks after initial visit. MotiveX, GearX, PinnacleX: Additional visit 6 weeks after initial visit.
• Applicable Products: All products, with variations in number of visits.

Urine Tests (Dipstick)

• Who is eligible? Women registered on the programme.
• How often? Included in antenatal visits.
• Applicable Products: All products.

Pathology Tests (Antiglobin, Platelet Count, and Rubella Antibody):

• Who is eligible? Women registered on the programme.
• How often? 1 test.
• Applicable Products: MotiveX, GearX, and PinnacleX.

Blood Group, Full Blood Count, and Rhesus Factor:

• Who is eligible? Women registered on the programme.
• How often? 1 test.
• Applicable Products: All products.

Creatinine:

• Who is eligible? Women registered on the programme.
• How often? 1 test.
• Applicable Products: GrowX, NormX, MotiveX, GearX, and PinnacleX.

Glucose Strip:

• Who is eligible? Women registered on the programme.
• How often? 1 test (GrowX, NormX); 2 tests (MotiveX, GearX, PinnacleX).
• Applicable Products: All options, with variations in frequency.

Haemoglobin Estimation:

• Who is eligible? Women registered on the programme.
• How often? 1 test (OneX, GrowX, NormX); 2 tests (MotiveX, GearX, PinnacleX).
• Applicable Products: All products, with variations in frequency.

Urinalysis:

• Who is eligible? Women registered on the programme.
• How often? 7 tests (OneX); 12 tests (GrowX, NormX, MotiveX, GearX, PinnacleX).
• Applicable Products: All products, with variations in frequency.

Urine Tests (Microscopic Exams, Antibiotic Susceptibility and Culture):

• Who is eligible? Women registered on the programme.
• How often? As indicated.
• Applicable Products: All products.

Scans

• Who is eligible? Women registered on the programme.
• How often? 2 pregnancy scans.
• Note: 3D and 4D scans are covered up to the rate paid for 2D scans on GrowX, NormX, MotiveX, GearX, and PinnacleX Options.
• Applicable Products: All products.

Paediatrician Visits

• Who is eligible? Babies up to 12 months registered on the programme.
• How often? OneX: 1 visit in the baby's first year. GrowX, NormX, MotiveX, GearX, PinnacleX: 2 visits in the baby's first year.
• Applicable Products: All products, with variations in frequency.

4. Health Line

• 24-Hour Emergency Health Advice
• Who is eligible? All beneficiaries.
• How often? As needed.
• Applicable Products: All products.

For all products, you can obtain authorisation and information via the XHealth App, web chat, email (assist@xhealth.co.za), or by calling 0860 55 55 55.